Mabunda, S., London, L., Pienaar, D. (2018). An Evaluation of the Role of an Intermediate Care Facility in the Continuum of Care in Western Cape, South Africa. International Journal of Health Policy and Management, 7(2), 167-179. doi: 10.15171/ijhpm.2017.52

Sikhumbuzo A. Mabunda; Leslie London; David Pienaar. "An Evaluation of the Role of an Intermediate Care Facility in the Continuum of Care in Western Cape, South Africa". International Journal of Health Policy and Management, 7, 2, 2018, 167-179. doi: 10.15171/ijhpm.2017.52

Mabunda, S., London, L., Pienaar, D. (2018). 'An Evaluation of the Role of an Intermediate Care Facility in the Continuum of Care in Western Cape, South Africa', International Journal of Health Policy and Management, 7(2), pp. 167-179. doi: 10.15171/ijhpm.2017.52

Mabunda, S., London, L., Pienaar, D. An Evaluation of the Role of an Intermediate Care Facility in the Continuum of Care in Western Cape, South Africa. International Journal of Health Policy and Management, 2018; 7(2): 167-179. doi: 10.15171/ijhpm.2017.52

An Evaluation of the Role of an Intermediate Care Facility in the Continuum of Care in Western Cape, South Africa

2School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa

3Western Cape Department of Health, Cape Town, South Africa

Abstract

Background A comprehensive primary healthcare (PHC) approach requires clear referral and continuity of care pathways. South Africa is a lower-middle income country (LMIC) that lacks data on the role of intermediate care (IC) services in the health system. This study described the model of service provision at one facility in Cape Town, including reason for admission, the mix of services and skills provided and needed, patient satisfaction, patient outcome and articulation with other services across the spectrum of care.

Methods A multi-method design was used. Sixty-eight patients were recruited over one month in mid-2011 in a prospective cohort. Patient data were collected from clinical record review and an interviewer-administered questionnaire, administered shortly after admission to assess primary and secondary diagnosis, referring institution, knowledge of and previous use of home based care (HBC) services, reason for admission and demographics. A telephonic questionnaire at 9-weeks post-discharge recorded their vital status, use of HBC post-discharge and their satisfaction with care received. Staff members completed a self-administered questionnaire to describe demographics and skills. Cox regression was used to identify predictors of survival.

Results Of the 68 participants, 38% and 24% were referred from a secondary and tertiary hospital, respectively. Stroke (35%) was the most common single reason for admission. The three most common reasons reported why care was better at the IC facility were staff attitude, the presence of physiotherapy and the wound care. Even though most patients reported admission to another health facility in the preceding year, only 13 patients (21%) had ever accessed HBC and only 25% (n = 15) of discharged patients used HBC post-discharge. Of the 57 patients traced on follow-up, 21(37%) had died. The presence of a Care-plan was significantly associated with a 62% lower risk of death (hazard ratio: 0.38; CI 0.15–0.97). Notably, 46% of staff members reported performing roles that were outside their scope of practice and there was a mismatch between what staff reported doing and their actual tasks.

Conclusion Clients understood this service as a caring environment primarily responsible for rehabilitation services. A Care-plan beyond admission could significantly reduce mortality. There was poor referral to and poor articulation with HBC services. IC services should be recognised as an integral part of the health system and should be accessible.

South African Department of Health. White paper for the transformation of the health system in South Africa. Notice 667 in the government Gazette No. 17910. http://www.gov.za/documents/download.php?f=187656. Accessed May 9, 2011. Published 1997.

South African National Department of Health. A Discussion Document on the Development of Subacute Care PolicySDC Policy Guideline. Directorate Health Facility Planning; 2012.

Schneider H, Schaay N, Reid S, et al. Policy Review of De-hospitalised Care Services for the Western Cape Department of health. Technical Report School of Public Health. South Africa: University of the Western Cape; 2012.

Lehmann U, Sanders D. Community health workers: What do we know about them? The state of the evidence on programmes, activities, costs and impact on health outcomes of using community health workers. Evidence and Information for Policy, Department of Human Resources for Health. World Health Organisation; 2007. http://www.who.int/hrh/documents/community_health_workers.pdf.